Definition
An ependymom is a rare tumour that can occur in the brain or in the spinal cord. The tumour originates in ependymal cells. These are the cells of the ependyma, a layer of epithelial cells which cover the walls of the ventricles (fluid-filled spaces in the brain) and the central canal of the spinal cord (see consultant source nr 1). The ependyma is like wallpaper covering the cavities in the brain and spinal cord. Ependymoma in the spinal cord are a subclass of the glioma (2). These are tumours originating in gliatissue, the support tissue of the central nervous system (1). Glioma are most abundant among children and young adults (2). Most ependymoma originate in the brain and not, as in Noor's case, in the spinal cord (3). Because intramedullar (located within the nerves of the spinal cord ) tumours have no room for expansion, compression of the nerves occur with neurological failures as a result. Ependymoma are very rare. They form part of about 25% of the spinal cord tumours. Spinal cord tumours in their turn only constitute 15% of again a rarely occurring group of tumours of the central nervous system (2). The neurosurgeon in attendance told Noor that only five people in the Netherlands had had a comparable condition during the last fifty years.

Here you see an intersection of the spinal cord

Central Canal
The ependyma covers the central canal of the spinal cord. In a cross-section of the spinal cord you can recognize the central canal as a small circle in the middle. It is surrounded by a butterfly shape of gray matter (nerve cells). The gray matter itself is surrounded by white matter ( nerve cell processes ).

Around the gray and white matter we find the same membranes that surround the brain. Starting inside and moving outside we find: the pia mater, arachnoid and dura mater. The arachnoid acts as a transport channel for the cerebral spinal fluid (brain/spinal fluid). You can see the whole as a bag of fluid in which the brain and the spinal cord have been suspended shockproof with short strings of connective tissue.

During embryonic development the central canal runs over the full length of the spinal cord. It is open and lymph is running through it. At a later age the canal is closing and no longer functions as a channel for lymph circulation (5). From the epithelial cells of this (almost) closed canal the four ependymoma in Noor's spinal cord originated.

Because of her Internet site, I asked Noor a number of questions. It has been five years since she was diagnosed with cancer.

Causal
Does cancer occur in your family?
My grandfather had prostate cancer and two uncles died of lung cancer.

Neurofibromatosis?
No.

Have you been in contact with carcinogenic substances? As a baby or later on in your life?
No, not that I am aware of.

And your mother during the pregnancy?
No, not that she remembers. We talked about it, because the neurosurgeon told us that 'malignant cells' have possibly entered the liquor during the shaping of the spinal cord. When during the pregnancy the spinal cord is formed, it lies on the outside of the foetus, he said.

Are you curious to a possible cause of your disorder?
I have accepted that very little is known about it, but I would like to know what caused it.

You say that you were never sick. Do you have an explanation for that? How is that for the rest of the family?
I was born with a healthy constitution. I do nothing in particular to keep it that way; I do not follow a diet or something. My sister was always sick. My brother and my father were never sick and my mother had the flu maybe once every three years or so.

Did you ever notice anything of lesions or problems with your legs and/or back before January 1997?
I had problems with my back in 1990. I had problems with my back before, but in 1990, I could not move at all. In the hospital, they discovered that my bottom vertebrae had grown together with my sacrum on the right side. My father had that same problem.

Medically
Was the loss of feeling limited to your left leg or were other body parts also involved?
Also on the left side of my body, from the umbilical point to my left breast I could feel neither cold nor pain.

What do you think, looking back, of your treatment?
The family doctor did very well. He reacted instantly and made an appointment with the neurologist in the hospital. The neurologist also did very well. When we examined the MRI scan, he was talking about "white spots". He asked about neurofibromatosis in my family and then very cautiously about cancer. However, he did not mention the word tumour or cancer. So when I asked him: "do you mean cancer?" , he said, "Yes, that is what I mean".
The neurosurgeon who carried out the biopsy has explained everything well. He told me that he had to remove a piece of the vertebrae and then open the dura to be able to operate on the tumours.
After the operation, he informed me that he only could have done a biopsy and that he could not remove the tumours because they had grown into the dura and with the nerves. He had not been able to do much. The radiologist was a mockery. He suggested radiation of my spinal cord where the four tumours are situated. The neurosurgeon told us that the complete liquor had to be radiated because there was a possibility that the tumour cells had been dragged all through the liquor. For that reason, my partner insisted to perform a MRI scan of the brain and a complete radiation of my spinal cord and brain.
The next day the radiologist phoned us and told us that this indeed would be the right treatment. Later on, he made another big mistake by giving radiotherapy to my ovaries. Until then, I put confidence in ´the people in white coats' but now I understood that nevertheless you have to pay critical attention to what they do. The radiologist, however, was the nicest person of the four.

Were you sufficiently informed?
No, I wasn't. I had to search on the Internet a lot.

Did you consider asking for a second opinion in an academic hospital?
No. Many people advised me to do so, but I put confidence in the neurological centre in the hospital. Besides that, much happened in a short time.

Have you considered or applied alternative healing methods?
No. I didn't use medicines except something against nausea caused by the radiation.

Visualisation?
Laying on the radiation table where I lay pinned down in the mask, I tried to picture "little packmen" who exploded because of the radiation. One has to do something!

Have you changed your way of living after your recovery?
We pay more attention to eating our daily amount of fresh vegetables and we eat fish more often.

On your site, you mention a number of symptoms, that continued to exist after the treatment, namely: numbness of the skin of the left leg, an inert right leg and balance impairments. Has there been a change in those symptoms?
No. My own idea is that during the biopsy a nerve has been touched, because those symptoms in my right leg arose directly after the operation. I can no longer raise my body with my right front foot. I think that my balance complaints are a direct consequence. I must always pay attention to where I'm going, otherwise I get disoriented.

Have you regained new symptoms?
Two years ago, I got tingles in both my legs. I informed the neurologist and he prescribed 12 times physiotherapy. This did not help, but I kept doing the exercises daily and I do have the feeling that the tingles have reduced somewhat. On the other hand, it might be possible that I got used to them. And sometimes I must sigh deeply while watching TV or laying in bed. Of course, my lungs were also radiated. Nevertheless, while doing sports, I have no problems at all.

What does the neurologist say concerning your symptoms when you see him on visits?
He says that I should not to complain because I was very lucky to survive. And I agree on that. I can do everything I want. You name it. If I want to make a parachute jump from a plane, I can.

Emotional
What did you think/feel when you heard there were four tumours in your spinal cord?
"So no MS?" I asked. "No, no MS", the neurologist said. "Good." Only when the neurologist said that I could not go on holiday to Africa and that I had to be treated right away, I realised that something serious was going on.

How did you deal with your sickness?
I used talk about it easily and gladly. I find that makes it less serious. I could always find someone to talk to. I also loved making jokes about it. My mother said to me, when my hear began to fall out and I was pulling it: "are you plucking the chicken?" We laughed about that. I never cried or lay awake and I never thought that I would die. I simply knew: I will recover. When I was diagnosed with ependymomas, they immediately said that these tumours were sensitive to radiation. That was reassuring. To be honest, the fact that it could be MS was more frightening. My general practitioner wrote that in the note for the hospital.

How did the people around you react?
Only later, when I had started worked again, I realised that they might have thought that I would die. But during my sickness, I took it as normal concern. My partner has never spoken about his fears because he would not loose my faith in him.

How do you react when you are confronted with new physical complaints?
It must be a consequence of the radiation, I think. I have had the maximum radiation on my spinal cord. The number of 30 radiations has been brought back to 28. The neurologist told me that for the next ten years there could be reactions because of the radiation. Nevertheless, I am not afraid. I will wait and see what happens.

How do you see your future?
I think that it will go fine. Every day, I do my exercises. And when I can keep my spine smooth by doing sports, the impact will exceed the expectations.

What part does your disorder play now, after five years?
None at all. Only when there is someone in my environment who has to go through the same process as I went through, my memories reappear. First, the setbacks you have to deal with until the turning point to good news.

4. NEUROLOGICAL ASPECTS

Numbness and weakness
What are 'numbness and weakness'?
Neurology distinguishes stimulus symptoms and numbness and weakness symptoms, both caused by a deviation in the nerve system (5).
Stimulus symptoms are redundant impulses (in Noor's case: tingles, hot sensing, convulsions). These impulses are labelled redundant because they arise without appropriate impulse from the outside. Therefore, there is no external cause for the felt tingles. Such not painful feelings, that arise without appropriate impulse from outside, are called paraesthesia.

There are numbness and weakness of the reflexes, the loco motor system, sensual functions, higher neurological functions and the autonomous nerve system. The partial numbness of the feeling (hypesthesia) in the skin of Noor's leg is an example of a sensibility dysfunction or a disturbance of a sensual function.

Several sources notice that by means of the numbness and weakness the location of a tumour can be stipulated. After all the nerves go from the several levels of the spinal cord to specific areas in the body.

The largest tumour in Noor's spinal cord was between the fourth and fifth thoracic vertebrae (somewhere between the shoulder blades) and according to diagram (6) should cause the following complaints: paralysis of the legs and (lower part) trunk; loss of feeling below the nipples/ribs. Checking with Noor learned that this indeed was correct. Although she makes no report on her web site there was indeed a loss of feeling in the lower part of the trunk, below the left breast.

Perception
Noor did not feel pain and temperature impulses on the skin of her left leg. How can this be explained?

The symptoms that led Noor to the general practitioner did not point to a failure of the motorial nerves. Noor could move her leg and walked in a normal way. The motorial nerves that incite the muscles to move, functioned well. However, there was a failure of the sensitive nerves.

These nerves transport information to the brain. The sensory nerve root (= the dorsal root) enters the spinal cord through the dorsal side. There are the ventral roots (the 'wingtips of a butterfly') with the sensitive nerves (5). This was also the place where, according to the surgeon, the largest of the ependymomas was growing deformed with the membranes.

Globally, the sensual perception (of the skin) goes as follow (5, 6). The sensors on cells in the skin receive an impulse (for example a pinprick). This impulse causes a pulse in a nerve cell (of the peripheral nerve system). The pulse is conducted by the peripheral nerve to the back root and enters that way the spinal cord (the posterior horn). A synapse in the spinal cord links the sensitive nerve to a nerve (of the central nerve system). By means of the spinal cord nerve, the pulse is conducted to the brain while passing the thalamus. When the pulse reaches the sensitive part of the cerebral cortex, in the part of the brain which can translate the pulse, then you realise you got a pinprick.

The spinal cord is the link between the peripheral nerve and the sensitive part of the cerebral cortex, or between the impulse and the realisation of it.

In Noor's case, the ependymomas caused such a compression of the spinal cord, that the route of the impulse to the brain was blocked. Also on other components of this route, something can go wrong. For example: damage of the myelin sheath (peripheral) or numbness and weakness of a part of the cerebral cortex (6).

Differential diagnosis
The general practitioner and the neurologist made, based on the anamnesis and/or research, differential diagnoses. Which neurological symptoms, resembling Noor's complaints, belong to these diagnoses?
To clarify the differential diagnoses, I have listed the neurological symptoms (6, 7). I have added the possibility of syrinx because the symptoms were striking similar with the phenomena in Noor's leg.

Disorder	Clinical picture	Neurological symptoms
The sickness of Lyme is caused by the spirochete borrelia burgdorferi that is generally transmitted by ticks that lives on several mammals and birds. The bacterium spreads by means of blood/lymph.	The sickness occurs in Europe, and acts frequently in the summer and early autumn, generally at children and adolescents who live in wooded areas.	Some weeks or months after the first symptoms (red ring around tick bite and feeling feverish) by approximately 15% of the patients arise nerve impairments.
Multiple sclerosis is a disorder where the eye -, brain - and spinal cord nerves lose myelin. On the affected spots, the nerves do not work or hardly work.	The disorder is found at younger people (20-40 years, more often with women than with men) that suddenly have problems with vaporous vision, seeing double or show motorial and sensitive deviations in several parts of the body.	To the early symptoms belong: tinglings, numbness and other strange gestations in arms legs trunk or face and loss of strength or fine locomotor system.
Neurofibromatosis (sickness of Recklinghausen) is a hereditary sickness where in the skin and other parts of the body much soft, fleshy tumours occur which exists from abnormal nerve tissue.	The tumours generally appear in puberty. Since it concerns a hereditary sickness, there will be probably more persons in the family with this illness.	One third of the persons with this disorder have neurological problems. Neurofibromatosis can damage each body nerve, but frequently grow on the roots of the spinal cord nerve. It can be a threat if it exercises pressure on the spinal cord.
A syrinx is a tube formed cavity in the brain or spinal cord, filled with fluid. These cysts are rare.	In approximately half of the cases, the cyst are already present at birth, but for unknown reasons they become larger during the teenager years or in adolescence. With older people, lesion or a tumour generally causes the cyst.	Generally, the nerves that perceive pain and temperature changes are most damaged. Cutting wounds and burns are relatively frequently seen with these patients because their fingers feel no pain or heat.

5. ORIGIN AND NATURE OF AN EPENDYMOMA

Causes
Can you imagine that in such a tiny canal, in the interior of the interior, wrapped up in membranes and in the bony vertebrae of the spine, protected by the blood-brain barrier, that on a spot like that, a tumour can grow? There are some ideas concerning the origin of ependymomas in the spinal cord canal, but there is no actual knowledge. An inventory:

Epithelial cancers possibly grow in six steps.
In the fifties mathematicians calculated that epithelial cells had to go through six stages before it could be transformed into a cancer cell. Those calculations were based on statistics from which they learned that cancer arises more frequently as the age ascends. Modern molecular biologists seem to be able to subscribe the findings of the mathematicians (2). That would mean that there are six (or more?) evil transformations that must have succeeded in that tiny canal in Noor's spinal cord. Exhibition to exogenous influences or bad lifestyle plays a part in the origin of epithelial cancers (2). But how can those factors reach this so well protected central canal?

The foundation for the ependymoma has probably been laid in the uterus.
Noor´s neurologist assumes an influence, that begins in the uterus. He explained to Noor: "during the embryonic stage, something has gone wrong and evil cells got into the liquor." Those cells can attach - at a certain moment - to brain or spinal cord membrane. When such a cell attaches to an ependymcell, an ependymoma will arise. This is perhaps supported by the next observation. Observation: the earlier there is a contact with carcinogenic agent, the bigger the chance of developing a carcinoma in younger years (2).
From experimental research, we have learned that there are certain chemical substances that are directly carcinogenic and that do not need six stages to malignant mutation. One of these substances (ethylnitrosamine) can pass the placenta of cats and causes brain tumours in the kittens. (2). Inquiry at a friendly chemist, made clear that ethylnitrosamine is a biochemical substance, that is possibly released when smoking the flesh of a pig.

The increase inclination of the tumour is possibly congenital.
There is to a model showing that cells preserve their foetal properties. A cell would continue sleeping after the first days of impregnation, and only later on be awoken and then grow very rapidly (7).

Tumours with children and young adults possibly arise in a different way than with the elderly.
I find it special that gliomas especially arise with children and young adults (2).

Malignant or benign
Cancer is typified by the following characteristics: neoplasia, infiltrative growth, metastases, loss of organisation, unrestrained growth and growth at the cost of the body (7). What can be said about ependymomas concerning these characteristics?

Neoplasia, loss of organisation, unrestrained growth: yes
According to the neurologist it concerned a slowly growing, branching tumour (stage I). There was a danger for developing from the existing 1st degree to the 2nd degree, and the chance of developing new tumours. He typifies the tumours "not benign, not malignant". NB. The degree indicates the harmfulness; the stage is stipulated by the scope and distribution of the tumour (8).

Infiltrative growth: yes.
With gliomas, it is difficult to differentiate the good and the malicious. At the degree I or II, one speaks about a low-grade glioma. A glioma in the degree III or IV is called high-grade. A low-grade glioma grows slowly. For this reason, these are called "relatively benign". In contrast to a benign tumour, low-grade gliomas are not sharply limited. The tumour cells are found among the healthy nerve cells. In most cases such a tumour cannot be totally removed surgically (9).

Metastases: not probable
A glioma seldom spreads to other organs (8). Spreading of tumours of the central nerve system is not usual. However, cells can be dragged with the circulation of the liquor and spread themselves (3).

Growth at the cost of the body: yes (however not in the sense of weight loss)
Spinal tumours hardly ever lead to death directly, but give serious neurological disorder with great disabling impact. (2)

Conclusion
The ependymomas in Noor's spinal cord meet several characteristics of malignity. The benign side of the matter is that the experts considered the chance of spreading to other organs limited. Also, the growth of the tumours did not go along with cancer attentive weight loss.
Perhaps the best summary is: ependymomas are mostly benign, but there are also malignant ependymomas. And benign tumours can change into malignant tumours (3). Noor herself calls her disorder "a benign form of cancer". This is typical for Noor. According to the theory, a benign cancer does not exist. However, Noor says: "the cancer was not aggressive and I have been cured, therefore I call it a benign cancer.

6. THERAPY

Because of the coalescence with nerve tissue and membranes, surgical disposal of the tumours was not possible in Noor's case. The treatment consisted of radiotherapy; chemotherapy was no option because of the blood-brain-barrier. What kind of mechanism can protect the brain and spinal cord for chemotherapy?

Blood-brain-barrier
The brain is protected from the blood circulation and the rest of the body by the blood-brain-barrier (BBB). This is a system of dense cells packed around the blood supply to prevent harmful substances to enter the brain. Feeding substances that are necessary for normal brain functioning are let through (10).
The BBB is created in the first trimester of the foetal stage. The secret of the BBB lies within the endothelial cells of the brain/spinal cord capillary. They form the anatomical basis of the BBB. Firstly the endothelial cells are so tightly joined together, that no chemical solution can pass. The only possible route is straight through the endothelial cells, but this is obstructed by two serial membranes in the cells. To be able to pass these membranes, the transport systems have to penetrate both membranes. Only glucose (food for the brain) and insulin succeed in passing the membranes (by means of the BBB insulin sensor). (11) Many medicines turn out to be unable to pass the BBB. On the Internet, I found that research is being done on BBB and the possibility to find a way to slip medicines through the BBB, for example on behalf of multiple sclerosis, Alzheimer and Parkinson. The latest news is that vitamin C might be a good carrier for medicines (12).
Also the impact of chemotherapy (on tumours in the spinal cord) is seriously obstructed by the presence of the blood-brain-barrier, causing the cytostatics to reach the tumour cell insufficiently. There is, however, a discussion concerning the application of chemotherapy at ependymomas, but so far the impact of chemotherapy has not been proved. There is, however, agreement on treating the tumour with radiotherapy (3).
N.B: when using chemotherapy is being discussed, this discussion will most likely be on the influence of the blood-brain-barrier. In Noor's case exclusive radiotherapy was chosen.

Radiotherapy
Radiotherapy uses ionising radiation. This radiation is aroused by radiation machines or is released from radioactive substances. Radiation is absorbed in live tissues. The entity of absorbed radiation is the Gray (Gy). When absorbing, the radiation electrons from the atoms and molecules in the body are freed (ionisation). These freed electrons can damage the hereditary material in a cell, which causes cells to die at the next cell divisions(prolific cell death) (2). The radiation volume is accurately calculated. The radio therapist indicates exactly what amount of radiation has to reach which place in the tumour and calculates what the maximum amount of radiation is, that can be accepted in the neighbouring tissues and organs. This dose must be beneath the tolerance dose, which means that the dose must be as low as possible, so that the chance of noticeable unacceptable damage of healthy tissue will be extremely small (2). The deeper the tumour, the stronger the radiation must be to penetrate the cancer cell (2). According to Noor's radiologist the required amount to destroy the ependymomas was 50-60 Gy, whereas the maximum amount of radiation the spinal cord can endure is 40-50 Gy. It was tricky balancing. The treatment changed at the last moment from 30 to 28 radiations. Noor received 50.4 Gy.

For protection of the ovaries, that lay in the area to radiate, the bottom part of the spinal cord was treated with electronic radiation. Electronic radiation is an other form of radiotherapy, that does not penetrate the body deeply and is mostly used at superficial tumours. With electronic radiation infertility and early meno pause were prevented.

Side effects
Cells differ in their capacity to repair damage. This difference appears especially between tumour cells and normal cells. These differences in convalescence capacity are used in radiotherapy by means of conventional fractionated radiation therapy (step-by-step radiation). By giving the radiation in smaller parts in a longer time, the healthy tissue that is damaged can repair itself, whereas tumour cells die when trying to split (2). Or, as it was stated by Ken Wilber, ..since cancer cell grow twice as rapidly as normal cells, the tumour is, after a successful therapy, entirely dead and the patient only half dead. (8).
Rapidly splitting cells (for example hair, mucous membranes) will show the damage shortly after the radiation, slowly splitting cells (for example nerve tissue) on the other hand will show damage sometimes after months or even years. (13)
The immediately occurring side effects of the radiation have been described by Noor on her Internet site (4). Long-term side effects of radiotherapy are (13):
Lange termijn bijwerkingen van radiotherapie zijn er ook (13):

EPILOGUE

Noor has been cured from very threatening tumours that might or might not have been malignant, but may become so. She has wonderfully recovered and lives on like before. The influence of her faith in healing, and of her character on the total healing process is no part of this essay. Because this subject has my full interest, I would like to quote Ken Wilber (psychologist and biochemist)(8).

"The new way of the psycho neuro immunology has proved persuadingly, that our thoughts and emotions have a direct influence to our immune system. The impact is not large, but it is measurable... Particularly imagination and visualisation have turned out to be the most important ingredients to the 'small but not futile' influence of the spirit to the body and the immune system."

In connection with research that dr. Sandra Levy did on a group of 36 women with breast cancer at an advanced stage. The degree of 'pleasure' was determined by means of written standard tests to measure the state of mind: "Most important factor for surviving in the oncology: the time that patients, after their first treatment, were free of sickness. But the second strongest factor was a high score on 'pleasure'. Pleasure gave, after cancer had spread, a greater contribution to the survival probability than the number of metastases found or the tumour location".

CONSULTED SOURCES

1. Pinkhof, Geneeskundig Woordenboek (1998); ISBN 90-313-1797-7
   
2. Oncologie (2001); onder redactie van C.J.H. van de Velde, F.T. Bosman, D.J.Th. Wagener; ISBN 90-313-3095-7
   
3. http://www.neurochirurgie-zwolle.nl
   
4. http://home.planet.nl/˜noorwout
   
5. Neurologie (1996); A. van Rossum, J.J. Jansen, J.L. van der Zwan; ISBN 90-238-3407-0
   
6. Merck Manual, Medisch Handboek (2000); ISBN 90-313-3069-8
   
7. ABC van de geneeskunde (2001); Ruud Oderkerk
   
8. Overgave en strijd (1993); Ken Wilber; ISBN 90-6350-060-2
   
9. Voorlichtingsfolder Hersentumoren, Nederlandse kankerbestrijding
   
10. http//:www.ms-sep.be (deze website bestaat niet meer)
    
11. http://www.med.ucla.edu/modules/news/
    
12. http://www.gezondheidsnieuws.net
    
13. Voorlichtingsfolder Radiotherapie, Nederlandse kankerbestrijding
    

Recommendations
(2) is theoretical but gives particularly much information;
(5) a clarifying book concerning neurology.
With regard to the Internet: (3) and (4) are recommendable.

SUPPLEMENT ON ESSAY EPENDYMOMAS IN SPINAL CORD D.D. MAY 2002

The article of Dr. Viera Scheibner (distributed by Irma Jansen on the day that I handed in my essay) reports the SV40 virus, that would have carcinogenic properties and is seen as something that can cause certain tumours such as ependymomas. I thought it to be of importance within the framework of my essay to check it out and to hereby give you the result.

WHAT IS THE SIMIAN VIRUS 40 (SV40)?
This polio vaccine was developed in the fifties by scientist Dr. Salk. In those years, the US were startled by extensive polio epidemics. Salk's vaccine was produced by grafting the poliovirus on kidney tissue of Asian rhesus monkeys. From 1955 large groups of people were vaccinated. The 40th (!) monkey virus that was discovered later in the polio vaccine, got the title SV40. This virus appeared to be able to cause rare tumours in test animals.

YES OR NO CARCINOGEN?
The American government and scientists from all over the world disputed for many years about the SV40 virus being carcinogen or not. According to the government it would not be epidemiologically proved that SV40 causes tumours in people and that the laboratory researches of scientists are based on errors. Fact is that the American government ordered in 1963 to purify the vaccine from SV40.

The question is whether the vaccine manufacturers have succeeded in doing so, because according to some, the virus has rapidly mutated and has therefore escaped the purification.

On a SV40 conference in Chicago in 2001, researcher Carbone stated that 62 researchers of 30 laboratories from all over the world still found SV40 in human tissues and tumours. The conclusion of the conference was that SV40 indeed occurs in human tumours, but there was no consensus concerning the role of SV40 at the origin of those tumours.

The virus has been detected in the following rare tumours:
1) mesothelioma (originating in the mesothelium, the epithelial tissue of e.g. the pleura)
2) brain tumours (especially ependymomas and a certain eye tumour)
3) bone cancers
4) other rare cancers for example hypofyse and shield gland.

It is alarming that Italian research from 1996 showed SV40 virus in 45% of the sperm samples and 23% of the blood samples of healthy donors, who were not vaccinated with the contaminated vaccine. This indicates that the virus has possibly found manners to spread - around the vaccination - through sperm - and blood contact.

SV40 IN RELATION TO EPENDYMOMAS
Tobey MacDonald MD (George Washington University) confirms that SV40 and the corresponding antigen have been found in several ependymomas, but also says that no conclusions are to be made yet. However, it is certain that SV40 can arise in ependymomas in monkeys and other mammals. He excludes the influence of surrounding factors, professional circumstances of father/mother or feeding pattern of the mother, when it concerns the cause of brain tumours (for example ependymomas) at children.

CONCLUSION
I am not certain whether the same vaccine was used in the Netherlands, but I assume it was. The possibility that the virus has spread around the vaccine and occurs in Europe, I find plausibly, reading the Italian research results. The possibility that SV40 has contributed in the origin of the ependymomas in Noor's spinal cord is in my opinion not to be excluded in advance.

SOURCES:
http://www.sfgate.com. An interesting historical survey on the site of the San Francisco Chronicle.
http://www.sv40cancer.com Among others an article authorised by Tobey MacDonald MD appeared in Medicine Journal of February 2002.

MARIANNE SMIT (mei 2002)